Chemotherapy Related Neuropathy: Managing this Nerve Wracking Problem

Editor's Notes

• #6: Read slide.A review of the literature resulted in identification of 3 existing self-report tools for CIPN.
• #11: A hypothesized mechanism for both taxane and platinum based neurotoxicity is the result of oxidative stress (Joseph, Chen, Bogen, & Levine, 2008; Mir et al., 2009). Accumulation of platinum within the dorsal root ganglia may decreased cellular metabolism and axoplasmatic transport in patients treated with platinum based chemotherapy (Argyriou, Polychronopoulos, Iconomou, Chroni, & Kalofonos, 2008; Milla et al., 2009). Paclitaxel induces a rapid decline in axonal mitochondrial membrane potential, spontaneous neuronal firing, and reactive oxygen species production, resulting in functionally impaired, swollen, and vacuolated axonal mitochondria in both unmyelinated and myelinated axons (Flatters & Bennett, 2006; Siau & Bennett, 2006; Wei, Flatters, Xiao, Mulhern, & Bennett, 2008).  Oxidative stress may induce an NF-kappa B inflammatory cascade in persons with peripheral neuropathy, resulting in increased levels of inflammatory cytokines (Kuhad & Chopra, 2009; Kumar & Sharma, 2010). Laboratory studies indicate that Elevated levels of inflammatory cytokines including (Cox 2, TNF-alpha, IL-1beta, TGF-1beta) have been associated with increased neuropathic symptoms in diabetic rats (Kuhad & Chopra, 2009; Kumar & Sharma, 2010; Negi, Kumar, & Sharma, 2011).
• #13: Preventative strategies have been the primary focus of research to date but have so far failed to provide effective methods to prevent it.Prevention may differ depending on neurotoxic agents the patient is receiving.Target underlying mechanisms behind CIPN, which are not well understood.
• #14: More research still needed because of small sample sizes in each study.
• #17: To measure side-effects associated with cancer treatments, large scale clinical trials often use grading scales, such as the National Cancer Institute’s (NCI) Common Toxicity Criteria for Adverse Events (CTCAE), WHO and ECOG scales.These criteria have been used to establish cut points for treatment toxicity, delays and/or reductions, rather than as comprehensive measures of the patient’s symptom experience. There are no guidelines for training of evaluators, no standardization of agreement as to what constitutes some subjective assessment of “weakness interfering with function”, ensuring wide variation ion scoring for the same patient presentation.In general, grading scales lack the sensitivity needed to capture the full impact of CIPN.
• #19: Fall risk increases with each cycle of chemotherapy
• #22: NP is often described as burning, shooting, stabbing, electric like, or pins and needles. An aggressive approach to pain management should be taken and may involve use of several different classes of medications.Pain is whatever the person says it is, experienced whenever the person says it is.
• #26: Requires aggressive treatment approach and frequent communication with the patientCaution: Even though these guidelines have been developed by experts and are evidence based, they may be of limited benefit for CIPN.A combination approach will probably be required.Add additional agents sequentially if partial but inadequate pain relief
• #34: These techniques may provide symptomatic relief ofnumbness and tingling for patients with CIPN with minimal foreseeable risks.
• #35: Allet and colleagues (2010) reported significantly improved balance and strength, increased walking speed, and decreased fear of falling in participants a 60 minute, twice a week for 12 weeks, strength, balance, and functional training program. The results were sustained for a period of six months. Furthermore, the training program was feasible and safe for persons with peripheral neuropathy.